6 Eye Issues After 40

[sidebar]At the end of a 2-year intensive writing project, Stephanie Smith, 44, noticed her near vision going south. When she opened her laptop to start her next assignment, her eyesight was even worse. "I went to the optometrist and was told I needed bifocals," says Smith, an artist, writer, and teacher in Bethlehem, PA, who has been wearing glasses since she was 4. "Jeez," I thought. "Bifocals? Bury me now, please."

To women like Smith, bifocals, along with gray hairs and skirted swimsuits, are visible evidence that they've crossed the threshold into middle age. "All I could think of was the old ladies in the library with glasses around their necks," Smith says. "That's just not how I see myself."

But like any other body part with lots of mileage, eyes wear out. And whether we've been happy with our glasses or contacts or never had vision problems, eye changes often feel as if they've come along overnight.

Here are six eye issues that are common after 40, and what you can do about them.[pagebreak]

PROBLEM: You have burning, scratchy eyes

It could be: Dry eye, caused by hormonal changes (especially a drop in androgen, a sex hormone) or an autoimmune disease. One, called Sjogren's syndrome, mostly affects women over 40.

Why it happens: Blinking usually distributes an even flow of tears around the eyes, keeping them moist and comfy. When the eyes don't produce enough or the right kind of tears, they can itch and burn.

Who's at risk: Everyone, but especially women in midlife. (And hormone replacement therapy won't help: Women taking estrogen are actually 70% more likely to have dry eye.) Overall, 52% of American women say they deal with dry eye symptoms on a regular basis.

What helps: Artificial tears, gels, and ointments. Doctors can also slip small silicone plugs into the drainage holes in the inner corners of the eyelids to help keep tears (artificial or your own) on your eyes longer.

After more than a decade, Lynette Sheppard, 57, has figured out how to manage her chronically dry eyes. "It started with perimenopause, and my eyes got so scratchy and itchy that I just gave up on wearing contacts," says the nurse-turned-blogger, who lives in Kualapuu, HI. "And to make it worse, I discovered I'm also really sensitive to the preservatives used in many products." For her, the solution has been daily single-dose eyedrops made without preservatives. "I use them midday, when my eyes are starting to bother me after working on the computer," she says. "And on bad days, like when the volcanic fog rolls in, I'll use an eye ointment at bedtime as well."

Dry eye needn't force women out of contacts, says Anne Sumers, MD, an ophthalmologist in Ridgewood, NJ, and a clinical correspondent for the American Academy of Ophthalmology. "You may not be able to wear them from 6 AM to midnight like you used to, but you should be able to wear them comfortably for 6 to 8 hours," she says. "Tell your doctor to keep trying."

Remedies include a broad array of over-the-counter drops, gels, and ointments. Dr. Sumers is also a big fan of lenses formulated for patients with dry eye. "They really are comfortable," she says. Ask about scleral lenses, which cover the white of the eye and have been found to help even in severe cases.

While the evidence isn't conclusive, some research suggests that a diet rich in omega-3 fatty acids, such as those in salmon and other fish, may reduce or help prevent dry eye. "Personally, I get my omega-3s from flaxseed oil, and I think it helps," says Dr. Sumers. (Read more about dry eye treatment with 9 Solutions For Dry Eye.)[pagebreak]

PROBLEM: You see floaters and flashes

It could be: Totally normal. But sudden changes could signal the start of a tear in your retina, which can lead to vision loss.

Why it happens: Eyes are filled with a clear, gel-like substance that slowly shrinks as we age, releasing tiny clumps of cells and debris. These drifting cells and debris cast shadows inside the eye, making it seem as if things are floating into view. Floaters can look like dots, circles, lines, clouds, or cobwebs. As the gel shrinks, it can also pull on the retina, creating what appear to be lightning streaks or flashes. These flashes can appear on and off for weeks or months.

Who's at risk: While their appearance increases as we age and can happen to anyone, floaters are more common among those who are nearsighted or have had eye surgery or any inflammation or injury to the eye.

What helps: You may need urgent care. See your eye doctor right away if you notice abrupt changes.

In 2009, Marti Weston, a teacher in Arlington, VA, noticed what seemed like little specks in her right eye, plus some flashes. "I called the eye doctor and said, 'I'm thinking it's time for an eye exam.' When I explained what was happening, the receptionist said, 'Can you come in now? Right now?' "

Weston, 60, quickly learned that while an occasional floater is normal, sudden changes can signal a tear in the retina. "My eye doctor saw me that day, and I didn't yet have a tear. He asked me to come again the next day and then the next. Sure enough, by then it was tearing."

Weston's doctor used a laser procedure to seal the tear, which fixed the problem. And while her left eye had remained clear, two years later she began seeing a sudden shadow "zipping in and out like a comet," she says. "I put off calling the doctor for a day, resulting in a detached retina. Luckily they saw me on a Saturday and were able to do the surgery, and it went well."[pagebreak]

PROBLEM: You hold papers far away, like you're playing the trombone

It could be: Presbyopia, which sounds way better than what it really means. It's Latin for "old man eyes."

Why it happens: In your early 40s, the lens of the eye begins to get stiff and less able to focus. Reading type at a normal distance becomes more difficult and eventually impossible.

Who's at risk: Anyone who remembers Jimmy Carter in the White House or saw Saturday Night Fever in a theater.

What helps: OTC reading glasses. When they no longer work, or if you already have prescription lenses, see your eye doctor.

"After the age of 40, we all lose some ability to focus on what's near to us," says Dr. Sumers. Yet many people fight off that first pair of reading glasses because of denial, vanity, or the idea that giving in to glasses will aggravate the problem. "The myth that wearing corrective lenses will somehow weaken your eyesight is really pervasive, but it's just not true," she says. "Your eyes are going to get worse with age whether you wear glasses or not."

The right prescription can make your vision as sharp as ever, although wearing progressive (multifocal) lenses, which provide multiple corrections within one lens and are prescribed far more often than bifocals, takes a little practice and patience. But it can be well worth it. "I'm 55," Dr. Sumers says, "and I wear multifocal contacts that allow me to see well enough to do eye surgery."

Minor environmental changes can be helpful too. "Add more light in your house, and explore e-readers, like a Kindle, that allow you to adjust font type and size," Dr. Sumers says.

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PROBLEM: You have trouble driving at night

It could be: A cataract.

Why it happens: Proteins within the lens start to clump, clouding vision. Gradually they turn the lens a yellowish color, creating a brownish tint in vision.

Who's at risk: Aging is the main factor (and more than 50% of people over 80 have cataracts). Family history, high blood pressure, diabetes, smoking, obesity, and extensive exposure to sunlight have also been linked.

What helps: Wearing sunglasses and brimmed hats may help prevent the problem; once you have a cataract, prescription glasses can help you live with it. But as vision becomes more severely affected, surgery, including the insertion of an artificial lens, may be required.

"A cataract is simply a clouding of the natural lens of the eye," says Lana Srur, MD, an ophthalmology professor at the University of Miami's Bascom Palmer Eye Institute. "It's like looking through a dirty window. Vision can become blurry and having difficulty with night driving and other forms of glare can also be symptoms."

Cataracts can be a side effect of other eye surgery as well. Weston, who has already had retinal repair in both eyes, recently required a cataract operation too. "There's a little irony in all this," says Weston, who also writes a blog about caring for aging parents. "I found myself using the handrails that I installed for my parents and my in-laws, who have had five cataract surgeries among them. And I'm pretty resigned to the likelihood that I'll need retinal surgery and eventually cataract surgery on the other eye as well."

The good news? Cataract surgery turns out to be many people's best friend. Not only is it one of the most common surgical procedures in the United States, it's also one of the safest and most effective, improving vision in more than 90% of cases. And it has a bonus: Many cataract-surgery patients are amazed and delighted to have vivid color back in their vision.

People can be thrilled with the immediate improvements, says Dr. Sumers. "Often, patients will come in thinking they want LASIK surgery [to correct nearsightedness], which frequently doesn't make sense in midlife—it can exacerbate dry eye, and many people will still need reading glasses afterward. But with cataract surgery, we put in implants specifically chosen for their vision problems." [pagebreak]

PROBLEM: GlaucomaGlaucoma is a major cause of blindness in the United States, yet of the 2.7 million people who have it, half are undiagnosed. It often has no symptoms in the early stages, and by the time it starts affecting vision, nothing can be done to regain that lost sight. Those with a family history of the disease are especially vulnerable. While glaucoma can strike at any age, risks begin to increase dramatically at midlife, which is why experts recommend that everyone have a baseline eye exam by age 40, with a follow-up exam schedule determined by what is found at baseline.

PROBLEM: Macular DegenerationWomen live longer than men, which puts women at a higher risk of age-related macular degeneration, a problem caused by changes in the part of the retina that controls central vision, including color and fine detail. AMD blurs and decreases that central vision, causing blind spots and making straight lines look bent. Risks, which are highest among Caucasians, begin to rise at age 55. About 12% of people 80 or older have some degree of AMD.

But before pooh-poohing concerns about AMD as a problem for the elderly, start taking precautionary measures to lower your odds of developing the condition. "Many of the risk factors are things we can address early in our lives, and they are very similar to steps we take for cardiovascular health," says Abdhish R. Bhavsar, MD, an ophthalmologist and researcher in Minneapolis and a correspondent for the American Academy of Ophthalmology. "Exercising regularly, watching your cholesterol and blood pressure, and eating a healthy diet, including plenty of leafy greens, fruits, and nuts, can all help."

A diet rich in omega-3s may also be beneficial, and since smoking is a major risk factor, quitting will help you literally see into the future.

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